The Cecil G Sheps Center at the University of North Carolina at Chapel Hill (UNC) is pleased to submit this application to initiate a T-32 postdoctoral training program in comparative effectiveness research (CER). This additional program will build on over 20 years of collaboration between the Sheps Center and AHRQ in pre- and postdoctoral training in health services research. The program will be directed by Dr. Tim Carey, director of the current program and of the Sheps Center. CER is a growing interdisciplinary activity, drawing from the disciplines of clinical medicine, epidemiology, health policy, and pharmacy. Our society has an urgent need to evaluate the best strategies of diagnostic testing and treatment so as to improve health care for our citizens. The components of CER include evaluation of current evidence through systematic reviews;observational studies and analyses such as pharmacoepidemiology and modeling research;conduct of large effectiveness trials;and dissemination and implementation activities. Our 13 core faculty are drawn from four health science schools (medicine, public health, dentistry, and pharmacy) and seven departments. UNC has substantial current activities in CER, including master task order contracts with AHRQ for systematic reviews through the Evidence-based Practice (EPC) network;observational studies through the DEclDE network;extensive practice-based research network (PBRN) activities including a master task-order contract with AHRQ;large randomized trials;and dissemination research. UNC is also an NIH CTSA site. Fellows will be expected to participate in ongoing content and methods research. Didactic work will include degree granting programs through UNC-CH's MPH or MS program for clinicians. PhDs will enroll in selected courses focusing on CER methods, as well as elsewhere on campus. Fellows will participate in a weekly integrative seminar, as well as a weekly seminar on CER methods. We are requesting funds to support five fellows for two years each, two to begin in Year 1 and three to begin in Year 2. We have also obtained agreement from four external sites with research complementary to UNCCH: Consumer's Union;the Dartmouth Institute for Health Policy;the Durham VA HSR&D Center;and the American College of Radiology Imaging Research Network (ACRIN). RELEVANCE: Recent initiatives by the lOM, the Federal Coordinating Council, ARRA legislation, and proposed health reform legislation have substantially increased the amount of comparative effectiveness research activity and its potential policy impact. As a result, the nation is experiencing a great need for more researchers to meet the demand in areas of systematic review, observational studies, effectiveness trials, and research dissemination. Skills that can be rapidly applied are especially important, and a related focus is enhancement of the methods involved in comparative effectiveness research.